Provider Demographics
NPI:1407883176
Name:WEINSTEIN, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4277 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5709
Mailing Address - Country:US
Mailing Address - Phone:516-731-7770
Mailing Address - Fax:516-731-7052
Practice Address - Street 1:4277 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 209
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5709
Practice Address - Country:US
Practice Address - Phone:516-731-7770
Practice Address - Fax:516-731-7052
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY141364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110042183OtherRAILROAD MEDICARE
NYAP301OtherOXFORD
NY01407818Medicaid
NY0C5417OtherHEALTHNET
NY33A031Medicare ID - Type Unspecified
NY0C5417OtherHEALTHNET